Fill and Sign the Affidavit Paternity Form

Affidavit of Paternity by Mother of Child State of ____________________________________ County of _______________________________ PERSONALLY appeared before me, the undersigned authority in and for said county and state, ______________________________, who, having been being first duty sworn by the undersigned Notary Public, deposes and says: 1. I am the mother of ____________________, an infant born on or about ________ (date) , in ___________________________________________________________ ( city, county, state). 2. I am not now married, and have not been married during the days next preceding the date of the birth of my said child. 3. The actual father of my said child is ____________________, who resides at ______________________________________________________________________________ ____________________________________________ (street address, city, county, state, zip code). It is physically impossible for any other person to be the actual father of my said child. 4. The said _________________________ and I lived together during the pregnancy from ______________ ( date) to ____________ (date) . However, said ______________________ did not ever legitimate or become a presumed father of my said child by publicly acknowledging the child as his own, receiving the child into his family, or otherwise treating the child as if she were legitimate. No child support payments have ever been made by the said ___________________ to her or to any other person for the support of the child. 5. No action has been brought, nor is any action pending, for the purpose of having declared the existence or nonexistence of the relation of parent and child between anyone and my said child ________________________________. ________________________________ (Signature) _________________________________ (Print or Type Name) SWORN to and subscribed before me, this the ____ day of ________________, 20____. __________________________________ NOTARY PUBLIC My Commission Expires: